URINARY TRACT INFECTION
1. Defn;
is the infection of the urinary
collecting system.
Simple UTIs are generally contained
in the bladder and urethra.
2. Causes of UTI
Bacterial
infections (gram -) are the
most common.
– E coli is the most common by far,
causing 75-90% of UTIs.
– Klebsiella species
– Proteus species
– Enterococcus species
– Staphylococcus saprophyticus
Adenovirus (rare)
[Link]
UTIs generally begin in the bladder due to
ascending infection from perineal
contaminants, usually bowel flora, especially
Escherichia coli
The bladder is the initial place for infection with
ascending progression of bacteria to kidneys
Bacteria invasion of bladder is more common if
urinary stasis or low flow conditions exists
(decreased voiding, incomplete voiding, reflux,
or other urinary tract abnormalities
Cystitis (infection of the bladder) in itself
causes reflux and can result in the
development of pyelonephritis
[Link] of UTIs
UTIs are more frequent in females than
males at all ages with the exception of the
neonatal period, during which UTI may be
the cause of an overwhelming septic
syndrome in male infants younger than 2
months
Uncircumcised males have a higher
incidence than circumcised males.
Uncircumcised male infants have a higher
incidence of UTI than female infants
Incidence is highest in sexually active
adolescent females
[Link] features
Neonates Infants
– Poor feeding
– Jaundice
– Fever
– Hypothermia or
– Vomiting, diarrhea
fever – Strong-smelling urine
– Failure to thrive
– Poor feeding In neonates/infants,
spread may often be
– Vomiting
hematogenous,
rather than an
ascending infection
Clinical features in UTI cont..
Preschoolers
– Vomiting, diarrhea, abdominal pain
– Fever
– Strong-smelling urine, enuresis, dysuria, urgency,
frequency
School-aged children
– Fever
– Vomiting, abdominal pain
– Strong-smelling urine, frequency, urgency, dysuria, flank
pain, or new enuresis
Adolescents are more likely to have some of the classic
adult symptoms. Adolescent girls are more likely to have
vaginitis (35%) than UTI (17%). Those diagnosed with
cystitis frequently have a concurrent vaginitis.
[Link] Studies
A. Urinalysis
– A urine specimen that is found to be
positive for nitrite, leukocyte esterase, or
blood may indicate a UTI. Approximately
20% of pediatric patients with UTIs have
normal urinalyses results.
– A clean-catch urine sample with more than
100,000 colony-forming units (CFU) of a
single organism is classic criteria for UTI.
– Suprapubic tap can be performed if unable
to obtain specimen
B. Imaging
Often delayed until infection
resolves
Renal ultrasound
– Depicts kidney size and shape
– Can diagnose urolithiasis,
hydronephrosis, hydroureter,
ureteroceles, and bladder distention
VCUG (voiding cystourethrogram)
– Depicts urethral and bladder anatomy
and detects vesicoureteral reflux (VUR).
[Link] of UTI
Uncomplicated UTI/Cystitis
– Young children (<3months) and children
with dehydration, toxicity, or sepsis should
be admitted to the hospital for parenteral
antibiotics
– Amoxicillin
– 2nd or 3rd generation cephalosporin
– Bactrim
– Treat for 7-10 days
END
PREPARED BY ;
BENARD KENEMO MD.
